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Herbs for Motion Sickness
Eric Yarnell, ND, RH (AHG)
Abstract
Motion sickness occurs commonly. Existing drug treatments
either carry unwanted adverse effects or are insufficiently ef-
fective. Scopolamine, one of the major drugs for treating
motion sickness, is a natural product found in many members
of the Solanaceae family. Two members of this family, Atropa
belladonna (belladonna) and Hyoscamus niger (henbane), are
discussed as safer whole-plant alternatives to isolated sco-
polamine. The best studied herbal medicine for motion sick-
ness, Zingiber officinale (ginger), is both safe and effective for
many people. A whole host of other plants in the same family
as ginger, the Zingiberaceae, are also antiemetic, including
Alpinia officinarum (lesser galangal), A. katsumadai (Hainan
or Katsumada galangal), Curcuma caesia (black zedoary),
C. zedoaria (white zedoary), C. amada (mango ginger), and
Renealmia alpinia (ixquihit), which are particularly discussed
in this group. Finally, the Lamiaceae or mint family contains
many antiemetic herbs. Mentha xpiperita (peppermint) and
M. spicata (spearmint) are particularly discussed. The novel
use of their volatile oils by inhalation as an alternative to other
routes of administration in motion sickness is highlighted.
Introduction
Motion sickness (also called kinetosis) is a complicated
phenomenon that critically depends on problems with the
vestibular system, but also involves the autonomic nervous and
digestive systems. Those affected by motion sickness suffer
nausea, vomiting, sweating, dizziness, and headache that can
last for hours after the initiating motion. Low gravity can also
trigger this same phenomenon (though it is usually termed
“space adaptation syndrome” or “space sickness” in this setting)
as the fluids in the vestibular system do not function normally in
such an environment. Motion and space sickness appear to result
primarily from a mismatch between visual, proprioceptive, and
vestibular cues about motion. With sufficiently strong motion
almost everyone will experience motion sickness, but there are
strong interindividual differences.
1
One genetic analysis found
some evidence that single-nucleotide polymorphisms of genes
related to balance and neurological systems were related to
susceptibility to motion sickness.
2
For unknown reasons, people
of Asian descent are more susceptible to motion sickness than
those of European or African descent.
3
Intriguingly, migraine headaches share very similar symp-
toms to motion sickness and the two processes share many
pathophysiologic features in common as well.
4
Two-thirds of
migraine sufferers report that they are also susceptible to mo-
tion sickness.
5
Genetic testing reveals similar single-nucleotide
polymorphisms between migraine and motion sickness suf-
ferers.
2
There is also an overlap in treatment between these two
conditions, with at least some of the same herbal treatments
used for both conditions.
Current prevention and treatment methods for motion sickness
have limitations and problems, especially causing drowsiness.
This is particularly a problem for pilots or others who need to
maintain mental acuity while being regularly placed in situations
that predispose to motionsickness. Interestingly, one of the more
widely used treatments, transdermal scopolamine, is a natural
product and is discussed more in the section on belladonna be-
low. Most other drugs used to treat motion sickness are either
anticholinergics such as scopolamine or antihistamines with
anticholinergic properties as well.
6
The antiemetic properties of
antihistamines and anticholinergics are a result of activity both in
the enteric and central nervous systems, making them particu-
larly helpful for motion sickness. Herbal therapies offer alter-
natives to existing conventional therapies, including those that
are single natural molecules, and will be discussed in depth.
Belladonna, Its Alkaloids, and Related Plants
Solanaceae-family plants, including Atropa belladonna
(belladonna), Scopolia carniolica (European scopolia), Datura
spp. (jimson weed), and Hyoscyamus niger (henbane) have been
used since antiquity.
7
These plants and others contain atropine (a
mixture of d- and l-hyoscyamine), d- and l-hyoscine, and other
antimuscarinic alkaloids. Scopolamine is another name for hy-
oscine and is derived from the genus Scopolia, which was named
by Linnaeus for Giovanni Antonio Scopoli (1723–1788), the
Austrian naturalist. The use of Solanaceae-family plants for a
range of uses, including pain relief and inducing amnesia during
surgery in ancient times, is well attested.
8,9
No convincing evidence could be found on ancient recog-
nition of the use of any of these plants for motion sickness,
despite their frequent use for many other purposes and despite
ample evidence that sea sickness was a common problem since
ancient times.
10
It is not clear when the concept of using them
as treatment for motion sickness developed. Clinical trials of
74 DOI: 10.1089/act.2016.29049.eya MARY ANN LIEBERT, INC. VOL. 22 NO. 2
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products, including belladonna, for motion sickness appeared
in the medical literature in Europe in the 1950s.
11,12
The FDA
approved transdermal scopolamine patches for motion sick-
ness in 1979.
Empirically, whole-plant belladonna and henbane are ef-
fective for preventing and treating motion sickness.
13
They are
less convenient than the transdermal patches, but work much
more quickly. At least one clinical trial in fact has used pure
oral scopolamine 0.3–0.6 mg as a single dose combined with
the patch to get more immediate (within 1 h) effects.
14
The
optimal efficacy of the patch is 6–12 h after application. The
upper end of total alkaloid content in henbane is 1.5%.
15
Exact
quantification of scopolamine was not identified, but it is likely
to be 0.1% or less of the total plant. The scopolamine content
of belladonna and jimson weed is <1%.
16
At a typical dose
of a 1:3 weight:volume tincture of henbane (thus extracting
from 300 mg of the original plant per 1 ml of extract), 0.3 mg
of scopolamine could potentially be present in 1 ml (25–30
drops). The typical starting dose of such a tincture in an adult is
5 drops (so at most 0.06 mg scopolamine would be expected),
though this is generally increased until clinical benefits occur
or the patient starts to get a mildly dry mouth and/or dry eyes.
Many adult patients have been able to take significantly more
than this without adverse effects and with increasing efficacy.
Clear signs of overdose on any of these plants include con-
fusion, pupillary dilation, and blurry vision; the elderly and small
children are more susceptible to these effects and so smaller
doses must be used with these populations. If any overdose signs
occur, then the patient should stop taking the herb, should take
activated charcoal to stop further absorption, and should either
be closely monitored if symptoms are mild and seem to be
passing or sent to the emergency room for treatment if severe or
getting worse. Physostigmine is a specific antidote, but is fairly
dangerous itself and should only be given in a hospital setting.
17
Whole-plant henbane and belladonna extracts contain a
range of alkaloids besides scopolamine as already men-
tioned. Anisodamine is one such alkaloid that actually shows a
cognitive-enhancing effect, even at doses 40 times higher than
scopolamine.
18
This likely contributes to the greater safety of
whole-plant extracts compared to single-molecular entities
such as isolated scopolamine.
Zingiberaceae-Family Plants
Many members of another family, the Zingiberaceae, are
also useful for motion sickness.
19
Perhaps the most famous and
definitely the best-studied member of the family for motion
sickness is Zingiber officinale (ginger).
20
However, many other
members of the family are antiemetic, including but not limited
to Alpinia galanga (galangal, Thai ginger), A. officinarum
(lesser galangal), Elettaria cardamomum (green cardamom),
Amomum subulatum and A. costatum (black cardamom),
Curcuma caesia (black zedoary), C. zedoaria (white or yellow
zedoary, Javanese turmeric, ezhu), Hedychium flavescens
(cream ginger-lily) and H. spicatum (spiked ginger-lily), and
Renealmia alpinia (ixquihit). These are all tropical plants and
have not been studied nearly to the extent that ginger has.
Several clinical trials have assessed the efficacy of ginger
rhizome for motion sickness. In one early trial, 36 adults highly
susceptible to motion sickness found ginger powder 940 mg
superior to dimenhydrinate and placebo in preventing symp-
toms when placed in a rotating chair.
21
Treatment was given
20–25 min before being placed in the chair. Another set of 13
adults highly susceptible to motion sickness took either 1 or 2 g
dry ginger rhizome powder before being placed in a rotating
chair in a separate trial.
22
Both doses effectively reduced time
to onset of nausea, severity of nausea, gastric hyperactivity,
and reduced serum vasopressin levels compared to placebo in
this double-blind, randomized trial. The same test system used
with 28 adults found that dry ginger rhizome powder 500 or
1,000 mg and fresh ginger 1,000 mg had no benefit in pre-
venting motion sickness or improving gastric motility com-
pared to placebo or scopolamine; the latter was quite effective
in this study.
23
At least one other circular motion trial failed to
find ginger more effective than placebo.
24
In a real-world double-blind trial, 79 naval cadets not used to
heavy seas were randomized to take dry ginger powder 1 g or
placebo.
25
Frequency of vomiting and cold sweats were sig-
nificantly reduced by ginger compared to placebo. The number
needed to treat in this study to prevent one case of vomiting and
cold sweats was calculated to be 19.
26
This does not support
ginger being a particularly strong treatment, but given the
safety of ginger it may still be clinically relevant. In another
double-blind trial, 1,489 tourists on a whale-watching tour
were randomized to cinnarizine, cinnarizine with domper-
idone, cyclizine, dimenhydrinate with caffeine, ginger root,
meclizine with caffeine, or transdermal scopolamine.
27
There
was no difference in efficacy or safety between the treatments,
though scopolamine showed a tendency toward being the least
effective and causing the most adverse effects.
Ginger is antiemetic by multiple mechanisms. In preclinical
studies in rabbits, ginger acted by inhibiting central and pe-
ripheral muscarinic and histamine-1 receptors.
28
Many other
studies show that it is a 5-HT
3
receptor antagonist.
29,30
Because
these effects are occurring both in the enteric and central ner-
vous systems, they are particularly suitable for motion sickness.
Ginger is extremely safe. Occasionally, it causes heartburn
(usually resolved by taking ginger with a little food), but
generally there are no other adverse effects at reasonable doses.
Patients should take 1 g of powder in capsules or 1–2 ml of
tincture 30–60 min before travel begins, and continue taking
this same dose every 2–4 h while traveling. It cannot be
strongly emphasized enough how much more effective ginger
is taken preventatively than once symptoms have commenced,
particularly vomiting (which makes it difficult to keep any-
thing down).
Galangal, a word derived from an Arabic form of a Chinese
word for Alpinia,liang-tiang (g
ao lia´ng ji
ang), is used to de-
scribe both Alpinia galanga (galangal, Thai ginger) and A.
officinarum (lesser galangal); see Figure 1. The rhizomes of
these plants are used and are very similar to ginger, including
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in appearance, though their flesh is more of a pale white than a
golden color. These herbs contribute to the unique taste of
many dishes in Thai cuisine, and their widespread use as food
attests to their safety.
Lesser galangal is a traditional Chinese and indeed Asian
medicine widely reputed to alleviate nausea and motion
sickness.
31
Diarylhepatonids (curcumin-like compounds),
flavonoids, and one sterol compound were all found to con-
tribute to the antiemetic effect of lesser galangal in one ani-
mal study.
32
Similar compounds in A. katsumadai (Hainan or
Katsumada galangal) and ginger have been shown to have
antiemetic properties.
33
No clinical trials were identified re-
garding the efficacy of any species of Alpinia for motion
sickness. Doses of tincture are 1–2 ml taken at least 30 min
(and ideally 1 h) before travel commences, repeated every 2–
4 h. Optionally, tea can be used, but this is not usually con-
venient during travel. Capsules are not widely available.
Granules could be used to make instant tea; the dose is 1–3 g
tid or more frequently as needed.
Many species of Curcuma have potential value for preven-
tion and treatment of motion sickness. Black zedoary, also
known as kali haldi (“black turmeric”), is a relative of C. longa
(turmeric). Unlike turmeric with its orange rhizome, black
zedoary has a blue-black rhizome. It is native to the central and
northeastern portions of India. Preclinical studies confirm that
a tincture of black zeodary shares the anti-emetic properties
seen in so many members of the Zingiberaceae family.
34
Again, clinical trials are lacking, but this promising medicine
should be studied further.
White zedoary has white-yellow rhizomes (paler than the
bright orange of C. longa) and has a strong traditional use very
similar to that of ginger.
35
C. amada (mango ginger) rhizome is
used both as a food and multifunctional medicine, including to
settle the stomach.
36
No relevant clinical trials were identified,
but absence of evidence does not prove absence of activity.
Both black and white zedoary can be dosed similarly to ginger.
Renealmia alpinia (ixquihit, naiku, jazmı´n de monte, misk’i
p’anqa) is a medicinal Zingiberaceae species native from
Mexico to South America. Though it is famous as a remedy for
snakebites, it is also well-known as an antiemetic to traditional
healers.
37,38
Its chemistry and mechanisms of action have been
little researched, and no clinical trials were identified. The
rhizome and leaf are used and are dosed similarly to ginger.
Mints Against Motion
A third botanical family containing many herbs useful
against motion sickness is the Lamiaceae or mint family.
Mentha xpiperita (peppermint), which is a hybrid between M.
aquatica (water mint) and M. spicata (spearmint), both Eur-
asian natives, is one of the most popular and widely available
in North America, but spearmint itself is probably just as
useful. Other mint-family antiemetics are listed in Table 1.
Peppermint steam-distilled volatile oil and (–)-menthol, a pri-
mary monoterpenoid in the oil, help relieve motion sickness and
other types of nausea and vomiting in part because they are 5-HT
3
antagonists and calcium channel antagonists, and by blocking
tonic production of acetylcholine in gastric neurons.
39,40,41
Peppermint and other mint-family volatile oils represent a
particularly promising approach because they can be inhaled,
bypassing the stomach altogether. Oral treatments of even
Many species of Curcuma have
potential value for prevention
and treatment of motion sickness.
Figure 1. Yarnell motion sickness drawing—Alpinia galanga
(Meredith Hale). Permissions: Drawing by Meredith Hale and rep-
rinted with permission.
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helpful medicine can, if given in too large a volume, trigger
stretch receptors in the stomach and trigger nausea. Inhalation
therapy avoids this risk. Postoperative inhalation of pepper-
mint oil was as effective as intravenous ondansetron or pro-
methazine suppositories in one preliminary trial in women who
had just undergone Cesarean sections and had anesthetic-
related nausea.
42
Another large (n5301) randomized trial
found that a blend of spearmint, peppermint, ginger, and car-
damom volatile oils significantly reduced postsurgical nausea
and vomiting, limiting the number of patients who needed
rescue medication, compared to an isopropyl alcohol control.
43
Although these are not trials in patients with motion sickness,
they do demonstrate a significant effect from inhaled volatile
oils and support the empirical observation of the benefits of this
treatment in motion sickness.
Oral use of peppermint and spearmint volatile oils is also
antiemetic. In one trial of patients undergoing cancer chemo-
therapy, peppermint or spearmint 2 drops (in capsules filled
with sugar) 30 min before and 4 and 8 h after each chemo-
therapy dose significantly reduced severity and incidence of
nausea and vomiting compared to placebo in one trial.
44
Again,
these results do not directly prove efficacy in motion sickness,
but suggest oral use of mint oils as an alternative to aroma-
therapy may be effective in that setting.
Typical dosing of peppermint or spearmint starts 30 min
before travel. Either the patient should inhale the oil of one of
these oils (or a combination of the two) or take 2–3 drops (in a
blank capsule or directly in the mouth). This should be repeated
every 2–4 h depending on the patient’s response. Optionally,
tincture can be used at a dose of 1–2 ml of either herb on the
same dosing schedule. They are generally very safe, but oral
use can trigger or exacerbate heartburn in some patients.
Conclusion
One of the major drugs in the world for motion sickness is
scopolamine, a natural product. The whole herbs that contain
this and related alkaloids from the Solanaceae family include
belladonna and henbane, which are also effective at treating
motion sickness, though clinical trials are lacking. The best-
studied herbal medicinefor motion sickness, ginger, shows great
promise and is both inexpensive and safe. Many other members
of the Zingiberaceae family are also antiemetic based on his-
torical and current clinical use, though research on them lags
behind their utility. Finally, the Lamiaceae (mint) family con-
tains many antiemetic members. Best studied are peppermint
and spearmint oils, which can be used by inhalation or oral
intake, for all types of nausea and vomiting (trials specific to
motion sickness are lacking, but they are empirically valuable).
These tools expand the therapeutic armamentarium against this
common problem and should be further researched.
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Table 1. Other Lamiaceae-Family Antiemetics
Herb Part used Dose* Notes
Melissa officinalis (lemonbalm) Leaf Tincture 1–3 ml Volatile oil can be used, but is very expensive
(inexpensive oils are usually synthetic and to
be avoided).
Nepeta cataria (catnip) Leaf Tincture 1–3ml
Pogostemon cablin (patchouli,
gu
ang huò xi
ang)
Leaf, flower Granulation 1–3 g Confirmed antimetic in chicks.
a
Agastache rugosa (licorice mint,
t
u huò xi
ang)
Leaf, flower Tincture 1–3 ml,
granulation 1–3g
Delightful flavor. Makes a delicious tea (use
2–6 g herb/cup fresh leaf).
Ocimum tenuiflorum (holy basil) Leaf, flower Tincture 1–2 ml tid,
volatile oil 2–3 gtt
Adaptogen with a wonderful taste, but also
antiemetic.
b
*All herbs should be started 30–60 min before travel and continued every 2–4 h during travel.
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Eric Yarnell, ND, RH (AHG), is chief medical officer of Northwest Nat-
uropathic Urology, in Seattle, Washington, and is a faculty member at Bastyr
University in Kenmore, Washington.
To order reprints of this article, contact the publisher at (914) 740-2100.
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